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BUILDI G PER IT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPART ENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br />BUSINESS PHONE:(209)46803121 <br />INSPECTION REQUEST-24 HOUR 'RECORDER:(209)46803165 <br />THE APPLICATION .MUST BE COMPLETELY FILUm OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br />-BUILDING PERMITS. <br />=z» <br />Scope of Work:A..I eW 1>We;L(...I tV '" <br />Project Address:I 2..l ~5"'1\/.L.Oc.V e rL S ..."0 'rA ':;lA...Ir~(2..J .L-od;U.qS""z..V), <br />Project Valuation:t-S-oooo Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br />Name:II~~£"e.TT A (LU?_Name: <br />Address:(2...),'S'""'IV.LowfJfl,.Stc.«'''''M~~tO~.Address:t l..1..t W ","Tc;r~T6l .a...)(2..d . <br />City~()d ;State:~.+_City:VIk Le"(~p R.,';"4 1 State:e ,.,....,--... <br />ZIP:q~Z.'-(L Ph#(2~)1~"1-2..oo tt ZIP:QS2..s:2 Ph#("l.••"h"l'l..-6~L x: <br />CONTRACTOR INFORMATION Ph#(z.'h 11.-()(,."l.~/l..ofi -~'Y -(..,3 (Q <br />Uc.No:S<:)(Q"("L Company Name:p fL~€:p("CJuJ :z:IV c. <br />7Address.,1.'t..,<AI ,A.-&L r"..,N (2.d City:Vitu..tn'~ILl i.J (J ~SfC,..ZIP:q~'2..-~z, <br />•--;;;;T <br />DESIGNER INFORMATION Ph#Q.oq)....,I "2..-t z,S " <br />Uc.No:Company Name:l>I~w D'Q....!ttr iNA <br />.\.J .- <br />St&-ZIP:4SL~7_Address:2"~V I:>rA-UiP'i''-k~~City:V..•..u.-€'r'~I fLlI..J 4~•v -LENDING AGENCY Ph#() <br />Company Name:A /I A <br />Address:/'-'//f City:St:ZIP: <br />Permit will be issued to an "Owner-Builder"Yes 0 No.,ia OFFICiAl USE ONLY <br />If yes,a completed Owner-Builder Verification Form must Identification Number: <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit. <br />DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br />By my signature below,I certify to one of the following: <br />I ~a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />be (requires written approval and OwnerlBuilder Verification Form signed and submitted). <br />I have read this construction permit application and the infonnation I have provided is correct. <br />I agree to comply with all applicable county ordinances and state laws relating to building construction.I authorize <br />representanves of this city or county to ;z:?;.boVe-identilied ~for inspection purposes, <br />Applicant's Signa re i i ~././J,'::-.L~.~~/~Date tit fit 2- <br />..~~1/ <br />For your convenienc cheddists detailing a ditional submittal requirements for various building pennit typesIareavailableattheBuildingOMIoncounter.D molltlon pennlt and mobile hom on foundation require check.list. <br />F:\Application Forms &Handou1sIHANDOUTS\8uilding Permit Application.docPage 1 of 2 <br />(Revised (07-08-10)